State Licensed Medical Review Nurse

Job Summary

Working remotely, the full-time State Licensed Medical Review Nurse will perform Skilled Nursing Facility (SNF) medical claims audits, documenting findings, generating audit letters, and supporting appeals processes while collaborating with a multi-location team.

Key Responsibilities

• Auditing claims for medically appropriate services in skilled nursing facilities according to established guidelines
• Documenting audit findings and generating letters that articulate these findings
• Collaborating with the audit team to improve medical policies and minimize appeals

Required Qualifications

• Active unrestricted RN license in good standing
• Minimum of five years of diversified nursing experience in inpatient or outpatient settings
• At least one year of experience with the MDS/RAI process
• One year of experience performing medical records review
• Expertise in ICD-9/ICD-10 coding guidelines as they relate to the MDS RAI process